Medical claims occur every time an insured patient makes a trip to the doctor’s office, hospital, clinic or other source of covered health care. Each visit must be properly documented and include vital information such as the patient’s name, the billing code for the procedure and the cost of the visit. It’s the job of the medical claims manager to make sure everything is done right; the assistant helps with the flow of paperwork.

Verifying the Details

Each form that leaves the treatment facility must be correct in every detail, or the insurance claim might be denied. According to Consolidated MD, a medical claims service, some of the most common errors resulting in nonpayment include spelling the patient’s name wrong, the wrong social security number, listing the patient’s gender wrong or getting the insurance contract number wrong. It often falls to the assistant medical claims manager to check such details before sending the form to the insurance company.

Checking Each Form

Each claim form submitted to an insurance company must be backed up by the appropriate documentation regarding the patient’s original problem, any treatment he received, what follow-up is required and other treatment information. The assistant claims manager is often the person responsible for making sure the patient’s file is complete. In a large office or hospital, the assistant manager may oversee a staff that does the checking and then report the status to the manager.

Controlling the Data

Part of the job of medical claims management is to track each claim from start to finish, since the loss of even a single form could cost the practice thousands of dollars. The claims manager and assistant manager together must track every claim that’s sent out and log when the claims are paid and follow up on any claims that aren’t paid in a timely fashion. This typically requires the use of computer systems and sophisticated claims tracking software, as well as contacting the insurance company regarding any claims that are not paid on time.

Check Regulation Compliance

The medical claims manager is ultimately responsible for insuring that the office is in compliance with all applicable standards and laws impacting the filing of claims. The assistant manager is often the person who follows up on directives from the manager to see that procedures are followed. This may include specific processes for privacy procedures, documentation of procedures and claims tracking. The assistant normally works closely with the manager and other office staff to implement any new procedures.